Before the procedure
Before a ventricular assist device (VAD) procedure, your care team checks your heart and other organs and determines which type of support you need. The testing depends on the type of VAD and your condition.
Before you receive an LVAD, your care team checks how well the right ventricle is working. The right ventricle must send enough blood through the lungs to fill the left side of the heart and the LVAD. An echocardiogram and heart pressure measurements during a right heart catheterization help the care team judge how well the right ventricle may work after surgery.
If you're getting a durable VAD, you may need to stay in the hospital for a few days before the surgery. While you're in the hospital, you may have other treatments for your weakened heart or heart failure.
During this time, tests are done to make sure a durable VAD is still your best treatment option. Tests may include:
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Blood tests. Different blood tests check your blood cell counts, how well your blood clots, and how well the heart, liver, kidneys and other organs are working.
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Electrocardiogram (ECG or EKG). This quick and painless test records the electrical signals in the heart. It shows how the heart is beating.
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Chest X-ray. A chest X-ray shows the size and shape of the heart. It can help your healthcare team diagnose some lung conditions.
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Echocardiogram. Sound waves create pictures of the beating heart. This test shows the structure of the heart and heart valves. It also shows how blood flows through the heart. An echocardiogram can help your healthcare team decide whether a VAD is the right treatment option for you.
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Right heart catheterization. A healthcare professional places a long, thin tube, called a catheter, in a blood vessel and guides it to the heart. The test measures pressures and blood flow in the heart. These measurements help the care team judge how well each side of the heart is working and what type of support may be needed.
Before your procedure, you can talk to your care team about any concerns and what to expect.
During the procedure
Getting a durable heart ventricular assist device often requires open-heart surgery. The surgery usually takes three or more hours. The exact steps and length depend on the device, the surgical approach and whether other heart procedures are needed.
During surgery, you can expect the following:
- A member of your healthcare team may shave hair from your chest around the surgical area.
- You get medicines through an IV. The medicines make you sleep and prevent you from feeling pain during the surgery.
- You are connected to a machine that helps you breathe during your surgery. This machine is called a ventilator.
- Your heart may be stopped using medicines during the surgery. If so, you'll be connected to a heart-lung bypass machine. The machine keeps oxygen-rich blood flowing through your body during surgery.
For many durable VAD surgeries, the surgeon makes a cut down the center of the chest. The surgeon separates the chest bone to better view the heart and then places the device. Surgeons can place some VADs using smaller incisions.
Durable VADs have several parts. The exact setup depends on the type of device.
- An LVAD takes blood from the left ventricle through an inflow tube. The pump sends blood through an outflow tube to the body's main artery, called the aorta. The aorta sends blood to the rest of the body.
- An RVAD takes blood from the right side of the heart or a large vein and sends it to the pulmonary artery, which carries blood to the lungs. The exact connection depends on the type of RVAD.
- A BiVAD supports both sides of the heart. The left-sided pump sends blood to the aorta, and the right-sided pump sends blood to the pulmonary artery. The exact setup varies and may include temporary or durable right-sided support.
For many implanted durable VADs, a wire passes through the skin and connects the pump to a controller and power source outside the body.
If a heart-lung bypass machine is used, you are taken off the machine after the VAD is in place and working properly.
During and after surgery, the care team closely watches blood flow, heart pressures and device function. The care team can quickly treat any problems.
After the procedure
You stay in the hospital after durable VAD surgery. How long you stay in the hospital depends on your health before the surgery and how quickly you recover. Your stay may last a week, several weeks or longer. Before your procedure, your care team explains what to expect.
In the hospital, your healthcare team watches you for complications. A tube drains urine from your bladder. Other tubes drain fluid and blood from your heart and chest.
During recovery, it's common to receive:
- Fluids and medicines given by IV.
- Antibiotics to prevent infections.
- Blood-thinning medicine to prevent blood clots.
- Medicines to help manage your pain.
Tell your care team if you have pain or if the pain medicine is not helping. Good pain control can make it easier to breathe deeply, cough and start moving. These steps may help lower the risk of complications.
As you recover in the hospital, your healthcare team helps you become more active and regain strength. Team members help you sit up, get out of bed and walk. If you need more time to improve your strength, a short stay at a rehabilitation center may be recommended.
If you have a temporary RVAD, you stay in the hospital while the device supports your heart. Your care team checks how well the right ventricle is recovering. The device may be removed when the right ventricle can provide enough blood flow without it. You may need to stay in the hospital after the device is removed while you continue to recover.
Leaving the hospital
Before you leave the hospital with a durable VAD, your healthcare team teaches you and your caregiver or support person how to use and care for the device, including how to dress the wire and how to protect the wire from pulling. You learn:
- How to change the dressing and care for the skin where the VAD wire leaves your body.
- What to do if there are signs or symptoms of infection, including fever, pain, a change in skin color or drainage.
- How to keep the device charged. It's important to always have spare batteries with you.
- How to check the controller for dirt and the batteries for damage.
- What to do if the VAD isn't working properly.
- How to shower without damaging the device.
- What to do if the device's alarm goes off.
The surgical team also checks how well your chest incision and wire exit site are healing. Follow the instructions you receive for wound care and tell your care team about drainage, increasing pain, or a change in skin color around an incision or the wire exit site.
Recovery continues after you leave the hospital. You may need time to rebuild your strength and endurance. Your care team helps you gradually increase activity and tells you when you can safely return to daily life activities, such as driving, exercising, going to work or being sexually active. Your care team may refer you to cardiac rehabilitation for monitored exercise and rehabilitation. You also will also likely get tips on how to safely travel with a VAD.
Don't hesitate to talk with your healthcare team if you have any concerns about living with a ventricular assist device.